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Paeds > Renal and urology > Flashcards

Renal and urology Flashcards

1
Q

How might babies with UTIs present

A

Fever

Lethargy

Irritability

Vomiting

Poor feeding

Urinary frequency

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2
Q

How might infants and children present with UTIs

A

Fever

Suprapubic abdominal pain

Vomiting

Dysuria

Urinary frequency

Incontinence

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3
Q

How might a patient with acute pyelonephritis present

A

Temperature > 38

Loin pain and tenderness

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4
Q

What investigations are needed for UTIs

A

Urine dip (clean catch sample)

If recurrent

  • Ultrasound (all under 6 months within 6 weeks)
  • DMSA (scan 4-6 months after illness, look for damage)
  • Micturition cystourethrogram (look for vesico-ureteric reflux)
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5
Q

What is the management for babies under 3 months with a UTI

A

Immediate IV antibiotics (ceftriaxone)

Full septic screen

Consider lumbar puncture

(Applies to all under 3 months with a fever, regardless of suspected cause)

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6
Q

What is the management of UTIs in children over 3 months

A

Consider antibiotics (trimethoprim, nitrofurantoin, cefalexin, amoxicillin)

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7
Q

What is vulvovaginitis

A

Inflammation and irritation of vulva and vagina

Common in girls 3-10 (less common after puberty, as oestrogen protects skin and mucosa)

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8
Q

What are the exacerbating factors for vulvovaginitis

A

Wet nappies

Use of soap in the area

Tight clothing that traps moisture

Poor toilet hygiene

Constipation

Threadworms

Pressure on area

Heavily chlorinated pools

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9
Q

How might a child with vulvovaginitis present

A

Soreness

Itching

Erythema around labia

Vaginal discharge

Dysuria

Constipation

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10
Q

What are the investigations for vulvovaginitis

A

Urine dip (leukocytes, but no nitrates)

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11
Q

What is the management for vulvovaginitis

A

Usually only need to avoid exacerbating factors

Oestrogen cream for severe cases

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12
Q

What is nephrotic syndrome

A

Basement membrane in glomerulus becomes highly permeable to protein

Most common in 2-5s

Classic triad: hypoalbuminaemia, proteinuria, oedema

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13
Q

How might a patient with nephrotic syndrome present

A

Frothy urine

Generalised oedema

Pallor

Deranged lipid profile

Hypertension

Hypercoagulability

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14
Q

What are the causes of nephrotic syndrome in children

A

Minimal change disease (treated with prednisolone)

Focal segmental glomerulosclerosis

Membranoproliferative glomerulonephritis

Diabetes

Infection

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15
Q

What is the management for nephrotic syndrome

A

High dose steroids (prednisolone, for 4 weeks, wean over 8 weeks)

Low salt diet

Diuretics

Consider albumin infusion

Consider prophylactic antibiotics

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16
Q

What are the complications of nephrotic syndrome

A

Hypovolaemia

Thrombosis

Infection

Acute or chronic renal failure

Relapse

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17
Q

What is nephritis

A

Inflammation within nephrons of kidney

Classic triad of: reduced kidney function, haematuria, proteinuria

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18
Q

What are the common causes of nephritis in children

A

Post-streptococcal glomerulonephritis (1-3 weeks after group B strep infection, get AKI, supportive management, consider antihypertensives and diuretics)

IgA nephropathy (in teens, treat with immunosuppressants (steroids slow progression of disease))

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19
Q

What is haemolytic uraemic syndrome

A

Thrombosis within small blood vessels throughout body

Triggered by shiga toxin (E coli 0157)

Classic triad of: haemolytic anaemia, AKI, thrombocytopenia

A medical emergency

20
Q

How might a patient with haemolytic uraemic syndrome present

A

Around 5 days after onset of diarrhoea

Reduced urine output

Haematuria or dark brown urine

Abdominal pain

Lethargy

Irritability

Confusion

Oedema

Hypertension

Bruising

21
Q

What is the management for haemolytic uraemic syndrome

A

Supportive care

Consider urgent referral for dialysis

Blood transfusion if needed

22
Q

What is enuresis

A

Involuntary urination

Most children out of daytime urination by age 2

Most children out of night time urination by age 3-4

23
Q

What is primary nocturnal enuresis

A

Child has never managed to stay dry consistently at night

Usually part of normal development

24
Q

What are the causes of primary nocturnal enuresis

A

Normal development

Overactive bladder

Fluid intake before bed

Failure to wake up due to deep sleep

Psychological distress

Secondary causes (chronic constipation, UTIs, learning disability, cerebral palsy)

25
Q

What is the management for primary nocturnal enuresis

A

Reassure parents that it will likely resolve by age 5

Less fluid in evening

Encouragement and positive reinforcement

Treat underlying cause

Enuresis alarm

Pharmacological treatment

26
Q

What is secondary enuresis

A

Wetting bed when previously dry for 6 months

Possible causes: UTI, constipation, T1DM, new psychosocial problem, maltreatment, consider abuse and safeguarding

Treat underlying cause

27
Q

What is diurnal enuresis

A

Dry at night, but occasionally incontinent during the day

Mostly in girls

Causes: urge incontinence, stress incontinence, recurrent UTIs, psychosocial problems, constipation

28
Q

What are the pharmacological managements for enuresis

A

Desmopressin (ADH analogue, reduces volume of urine produced)

Oxybutynin (anticholinergic, reduces contractility of bladder)

Imipramine (tricyclic antidepressant, relaxes bladder and lightens sleep)

29
Q

What is autosomal recessive polycystic kidney disease

A

Presents in neonates

Usually picked up on antenatal scanning

Cystic enlargement of renal collecting ducts

Oligohydramnios and pulmonary hypoplasia

Congenital liver fibrosis

May need dialysis in first few days of life

May have end stage renal failure before starting school

Poor prognosis (1/3 die as neonates)

30
Q

What is a Wilms tumour

A

Tumour of the kidneys in children

Usually affects under 5s

31
Q

How might a patient with a Wilms tumour present

A

Mass in abdomen

Abdominal pain

Haematuria

Lethargy

Fever

Hypertension

Weight loss

32
Q

What are the investigations for Wilms tumour

A

Ultrasound abdomen

CT/MRI for staging

Biopsy

33
Q

What is the management for a Wilms tumour

A

Surgical excision (of tumour and kidney)

Adjuvant chemotherapy and radiotherapy

Good prognosis with early treatment

34
Q

What is a posterior urethral valve

A

Tissue at proximal end of urethra, causes obstruction of urine flow

In newborn males

Can develop hydronephrosis

Increased risk of UTIs

35
Q

How might mild cases of posterior urethral valve present

A

Difficulty urinating

Weak urine stream

Chronic urinary retention

Palpable bladder

Recurrent UTIs

Impaired kidney function

36
Q

How might severe cases of posterior urethral valve present

A

Bilateral hydronephrosis

Oligohydramnios (get underdeveloped fetal lungs, respiratory failure shortly after birth)

37
Q

What are the investigations for posterior urethral valve

A

Picked up on antenatal ultrasound

If presenting at birth: abdominal ultrasound, micturition cystourethrogram, cystoscopy

38
Q

What is the management for posterior urethral valve

A

Mild: monitor, temporary urinary catheter

Definitive management: ablation or removal (via cystoscopy)

39
Q

What are the risk factors for undescended testis

A

Family history

Low birth weight

Small for gestational age

Prematurity

Maternal smoking during pregnancy

40
Q

What is the management for undescended testis

A

Newborns: watch and wait (likely to descend by 3-6 months)

If not descended by 6 months, orchidopexy (at 6-12 months)

41
Q

What is hypospadias

A

Urethral meatus displaced to ventral side of penis (anywhere between further down glans to base of shaft)

Have an abnormal foreskin

Diagnosed during newborn examination

42
Q

What is the management for hypospadias

A

Not to be circumcised until seen by a urologist

Mild: no treatment needed

Surgery: at 3-4 months (correct position of meatus, straighten penis)

43
Q

What are the complications of hypospadias

A

Difficulty directing urine

Cosmetic and psychological concerns

Sexual dysfunction

44
Q

What is a hydrocele

A

Collection of fluid in tunica vaginalis

Simple: common in newborns, trapped fluid gets reabsorbed over time

Communicating: tunica vaginalis connected to peritoneal cavity via processus vaginalis, size fluctuates over time

45
Q

What are the investigations for hydrocele

A

Physical examination (soft, smooth, non-tender swelling, transilluminates)

46
Q

What is the management for hydrocele

A

Simple: resolves by age 2

Communicating: surgery (remove or ligate processus vaginalis)

Paeds (17 decks)

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